Phineas Gage: A Case Study in Brain Injury and Personality Change

One famous example of damage to the orbitofrontal area of the prefrontal cortex was the first case to be described, in 1848. A 25-year-old railroad foreman named Phineas P. Gage was tamping blasting powder into a hole in a rock with a metal rod when the blasting powder exploded. The rod—3 feet 7 inches long and 1¼ inches thick—was driven through his left eye and brain and emerged through the top of his skull. After a few minutes of convulsions, Gage got up, rode a horse three-quarters of a mile into town, and walked up a long flight of stairs to see a doctor. He recovered well, with no notice able sensory or motor deficits. His associates, however, noted striking personality changes. Before the accident, Gage was a responsible, capable, and financially prudent man. Afterward, he appeared to have lost his social inhibitions; for example, he engaged in gross profanity, which he did not do before his acci dent. He was impulsive, being tossed about by seemingly blind whims. He was eventually fired from his job, and his old friends remarked that he was “no longer Gage.”